Access to Improved, Usable, and Accessible Sanitation Facilities

Improved: Improved sanitation facilities: Hygienically separate excreta from human contact. Examples: flush/pour-flush toilets, ventilated pit latrines, composting toilets. Unimproved facilities: Pit latrines without slabs, hanging or bucket latrines. Usable: Available: Toilets are accessible at all times. Functional: Toilets are not broken, blocked, and have no cracks or leaks. Water is available for flushing. Private: Closable doors lock from the inside; no large gaps in the structure. Dedicated for Staff: Separate toilet facilities for patients and staff. Sex-Separated with Menstrual Hygiene Facilities: At least one toilet is separated for women/girls, with a bin with a lid, water, and soap in a private space for washing. Accessible for Users with Limited Mobility: Meets national/local standards. If absent: No stairs/steps, handrails, door at least 80 cm wide, and reachable door handle and seat.

Sanitation in health care facilities should ensure the hygienic separation of excreta from human contact. Sanitation is also important for dignity and human rights and has an important gender element, as toilets should ensure privacy and safety for the needs of women and girls.
Questions G-S1 to G-S6 ask about the availability of usable, improved toilets for patients and staff in a given service area to provide a general assessment of how well sanitation facilities support hygienic separation of human waste from user contact and uphold patient and staff rights, dignity and comfort. Certain sanitation technologies are more likely than others to hygienically separate human excreta from human contact. These are categorized by the JMP as “improved” sanitation facilities, while others are labelled as “unimproved,” following the same definitions and categories used for household-level monitoring. Questions G-S1 and G-S2 ask about the type (to assess whether improved or unimproved) and usability of toilets on premises.
Questions G-S3-6 aim to understand more details about those toilets. Firstly, G-S3 solicits information about staff-dedicated toilets (regardless of whether they are sex-separated) which is important in health care facilities to reduce risk of infections, particularly in outbreak situations. Question G-S4 seeks to understand if toilets are sex separated such that there is at least one usable toilet available
for women and girls. The toilet for women and girls should also provide facilities for managing menstrual hygiene needs (G-S5).
Finally, question G-S6 captures whether any of the toilets are suitable for users with limited mobility. This toilet(s) must be accessible to patients and does not need to be sex-specific as facilities may have one gender neutral toilet for users with limited mobility.
The minimum number of toilets required to meet the criteria for a basic sanitation service is one toilet dedicated for staff and one gender-neutral toilet for patients that has menstrual hygiene facilities and is accessible for people with limited mobility.

RECOMMENDED SURVEY QUESTIONS (Q)

G-S1 - what type of toilets/latrines are at the facility for patients?
Response options: flush/pour-flush toilet to sewer connection  / flush/pour-flush toilet to tank or pit  /  pit latrine with slab  / composting toilet  / flush/pour-flush toilet to open drain  / pit latrine without slab/open pit  / bucket  / hanging toilet/latrine  / no toilet/latrine (no more questions)  /  other (specify)
Note: If more than one type of toilet is used, the most common type of toilet/latrine  in the service area should be selected. 
G-S2  - is at least one toilet usable (available, functional, private)?
Response options:   yes  / no
Note:  To be considered usable, a toilet should be available, functional and private  at the time of the survey or questionnaire.  Toilets are available when on premises, doors are unlocked or with a key  available at all times. To be  functional, the hole or pit is not blocked, water is  available for flush/pour flush toilets, and there are no cracks or leaks in the toilet structure. To be considered private, the toilet stall has doors that can be  locked from the inside and there are no large gaps or holes in the structure. If  any of these criteria are not met, the toilet/latrine is not counted as usable.
G-S3-6   Are there toilets that . . . 
3.  Are dedicated for staff?  yes  /  no
4.  Are in sex-separated rooms?  yes  /  no
5.  Have menstrual hygiene facilities?  yes  /  no
6.  Are accessible for people with limited mobility?  yes  / no

Note: 
 3. Staff toilets should be for the exclusive use of staff. 
 4. Toilets can be in a room with multiple stalls or in a private room with a  single toilet. Toilets in rooms with multiple stalls should all be dedicated  for use by either women or men. 
 5. A toilet can be considered to have menstrual hygiene facilities if it  
• has a bin with a lid on it for disposal of used menstrual hygiene  products, and  
• water and soap available in a private space for washing.
 6. A toilet can be considered accessible for people with limited mobility if it meets relevant national or local standards. In the absence of such standards, it should meet the following conditions: 
• can be accessed without stairs or steps,
 • handrails for support are attached either to the floor or sidewalls, 
• the door is at least 80 cm wide, and
 • the door handle and seat are within reach of people using wheelchairs or  crutches/sticks.